maryannewaweru

A Kenyan Journalist Writing About Health

Turkana’s Children Race for Survival

By Maryanne Waweru-Wanyama

Among some mothers in Turkana, a newborn does not start breastfeeding until he responds to his name.

“After she gives birth, different names are called out and only when the newborn responds positively to a name will he begin breastfeeding,” says Nicholas Losike, a community health worker in Loima district, Turkana.

Losike says this traditional naming practice, which is still observed by some adherents, serves as one of the greatest challenges health workers face as they advocate for exclusive breastfeeding where the newborn is fed nothing else but the mother’s breastmilk for the first six months of life.

As a name is called out and the child shows no enthusiasm about it, it means he has rejected it, prompting more names to be called out. But when the child hears a particular name, opens his mouth and reaches out for his mother’s nipple, it means he has accepted the name and only then can his mother begin to breastfeed him.

“On average it takes about two days for the child to ‘respond’ to a name. Sometimes it can take even longer. In the meantime, the baby is fed on boiled goat or camel milk,” says Losike.

PASSIONATE: Nicholas Losike, a community health worker in Turkana. Photo/Maryanne Wanyama

Photo: Nicholas Losike, a community health worker

Even if the mother has delivered in a health facility, she will argue with the nurses about it and if they insist on her breastfeeding the newborn before he responds to a name, she will sneak out of the hospital, he adds.

Yet, the World Health Organization (WHO) recommends that mothers initiate breastfeeding within the first hour of birth. This is because of the immense benefits that breastmilk offers the infant.

According to Terry Wefwafwa, the head of nutrition and dietetics at the Ministry of Health, breast milk contains all the nutrients that an infant needs in the first six months of life. “Mothers should breastfeed as soon as possible after birth. This is because the first thick yellowish milk she produces called colostrum is filled with antibodies that give the newborn immunity from infection. It is actually the baby’s first immunisation,” she says.

Breastfeeding, according to Wefwafwa, is the single most effective prevention intervention for ensuring child survival and healthy development.

So when mothers such as those in Turkana discard this first milk due to long-held traditions, it gives the newborns a disadvantaged start to a healthy life as they miss out on the free and available first immunisation.

It is perhaps such cultural practices that contribute to a high infant mortality rate in Turkana, which stands at 60 in every 1,000. The health status of children in Turkana is wanting, with only 54 per cent of children aged 0-5 years being fully immunised, which is below the national average of 83 per cent.

This is partly attributable to the lack of quick access to health care services, forcing residents to trek long distances in the harsh, arid climate to reach health facilities.

“Many mothers take days to get to a dispensary or hospital, so they only come for services like immunisation when they are coming to seek other treatment services. We have women who bring in children for their first immunisation at 10 months,” says Susan Ilikwel, a 28-year-old mother of three in Namoruputh division.

Turkana has a population of 855,000, with only one doctor for every 52,434 people. This is against the universal recommendation of one doctor for 1,000 people.

The issue of child deaths in Turkana county is further compounded by the high maternal mortality rate, which stands at 1,500 deaths per 100,000 live births — which is three times the national average. Often, a mother’s death leaves devastating consequences for her family.

Findings from the study A Price too High to Bear released in March 2014 by Family Care International (FCI), the International Center for Research on Women (ICRW) and KEMRI/CDC demonstrated the great link between maternal deaths and neonatal mortality. Of the 59 maternal deaths in the study, only 15 babies survived the first 60 days of life. The deaths of mothers, most of who are in their productive years and engaged in different economic activities only deepens the poverty levels in the home. In some households in the study, surviving children had to be withdrawn from school because of economic disruptions. Often, the sudden death of a woman from pregnancy or childbirth-related causes begins a chain of losses that compromises her children’s health, education and future opportunities.

The WHO states that children from the poorest households are nearly twice as likely to die before their fifth birthday than children in the richest households. It is indeed a tough life for poor children as they struggle for food, health, education and other necessities that would enable them enjoy healthy mental, physical, emotional and spiritual lives.

With Turkana County ranked as the poorest county in Kenya, life for a child here is difficult, with the most pressing health problem being malnutrition. Malnutrition is marked by a deficiency of essential proteins, fats, vitamins and minerals in a diet. Without these nutrients, it becomes difficult for a child to achieve optimum health. Assessment reports indicate that the Global Acute Malnutrition level in Turkana is at 28 per cent, which is high considering the WHO threshold is 15 per cent.

Recurring droughts, increasing populations that have put pressure on the county’s resources, as well as insecurity characterised by clashes over water and grazing pastures as well as frequent cattle raids have compounded food insecurity issues for Turkana’s pastoralist population.

However, it is not all gloom for the county, as both the national and the country governments are putting in place measures aimed at bettering the lives of Turkana’s mothers and children.

In June 2013, the national government introduced free maternity services in all public health facilities. This move has seen an increase in the number of women accessing antenatal care services and subsequent delivery in hospitals.

With the cost barrier eliminated, the Turkana county government has put in place measures to ensure that pregnant women and children have better access to health services. “Because of the long distances women have to walk to access a health facility, we have now ensured that each ward in the county has at least one health centre. There will be additional 30 more health centres by the end of this year. With the assistance of partners, we have put up a model maternity section at the county’s referral hospital that will specifically take care of the health needs of mothers and children,” says Peter Ekai, Turkana’s deputy governor.

According to Ekai, the county has further committed 2.1 billion shillings to the health sector, a move that is expected to increase the positive health outcomes in the county.

“We also acknowledge the strategies that the Kenyan government has established at national and county levels with regard to mothers and children. One is the introduction of free maternity services which has seen more Turkana women access services in hospitals, and second is the introduction of free rotavirus and pneumococcal vaccines in public hospitals which will no doubt see more of our children surviving their childhood.”

Ekai was speaking at Lodwar Mixed Primary School during an event called ‘Race for Survival’ organised by the children’s rights organisation Save the Children on October 17 to mark the UN International Day for the Eradication of Poverty. On this day, children from across the world participated in a symbolic race aimed at highlighting the plight of children from the most difficult places in the world.

DISADVANTAGED: Children run in an event to mark the UN International Day for the Eradication of Poverty in Turkana on October 17. Photo/Maryanne Wanyama

Photo: Turkana children participate in the Race for Survival

In Kenya, the celebrations were marked in Turkana county where the focus was on malnutrition. Kenya loses 108,000 children each year from preventable diseases like diarrhoea, pneumonia, malaria and other neonatal causes. Malnutrition however remains a major threat to the survival, growth and development of children where it contributes to more than 3.5 million preventable deaths annually in Kenya.

Children who participated at the Race for Survival called on both the national and county governments to pay urgent attention to Turkana’s children. “We ask that our health and nutrition needs be given priority. We want our governments to ensure that every child has access to a nutritious diet as this will help us live longer,” said Elizabeth Sakasa, a 12-year-old girl from Lodwar Mixed Primary School.

Article courtesy: The Star.

Jacklyne Nekesa: “I Lost my Uterus to a Rare Form of Cancer”

By Maryanne Waweru-Wanyama

Five years ago, Jacklyne Nekesa Nyongesa had her uterus removed, in a surgical procedure known as a hysterectomy. She was aged 35 then and even though she did not wish to have her uterus removed, it was her only option if she needed to stay alive.

“Ever since I was a little girl, I always desired to have my own child, but nature did not seem to favour me in that way. I have now accepted the fact I will never give birth to my own child,” she says.

Jacklyne’s journey to having her uterus removed began in 1997 when, for a period of time, she experienced heavy bleeding accompanied by intense pain to the extent that she would pass out. With time, the bleeding became constant and would see her bleed every single day of the year. And it was not light bleeding, for she would bleed in huge clots.

“Pads would not help as the blood would sip right through them and onto my clothes. I always had to carry a change of two or three clothes in my handbag. I was studying at that time and it became difficult for me to move around as I had to constantly keep dashing into public toilets to change my soiled clothing. Eventually, I stopped going to college and preferred to stay indoors,” she recalls.

Selina Cimmone

Photo: Jacklyne Nekesa during the interview.

As the bleeding continued, it would be accompanied by feelings of nausea, vomiting and extreme fatigue. Jacklyne then decided to visit Kenyatta National Hospital where the doctors ran a series of tests on her, including a pregnancy test.

“The tests showed that my pregnancy hormones (hCG) were very high. This puzzled me because I knew for a fact I was not pregnant as I was not sexually active. An ultrasound later on showed that I had abnormal growths in my uterus. These growths were mimicking a pregnancy, hence the symptoms of a firsttrimester pregnancy,” she says.

The doctors further took tissue samples from Jacklyne’s uterus, which established the presence of cancerous cells along her uterine wall.

Jacklyne was diagnosed with an unusual type of cancer called choriocarcinoma. She had to undergo two surgeries in a span of six months to remove the abnormal growths, as well as undergo chemotherapy to destroy the tumour cells. She underwent a total of 15 cycles of chemotherapy.

However, the pain and bleeding never stopped, despite the two forms of treatment.

“As the years went by and the bleeding and pain got worse, the doctors recommended having my uterus removed, but I resisted this. I believed I would heal, meet a nice man, get married and have babies,” she says.

For the next decade, Jacklyne experienced heavy bleeding accompanied by intense pain everyday. Due to the loss of blood, she became anaemic and lost count of the number of times she underwent blood transfusions. The disease affected not only her physical and emotional health, but her social life too.

“I could not date. How could I be intimate with a man yet I bled every single day of my life?” she remembers. Finally, in 2009, Jacklyne gave in and heeded the doctor’s call to have her uterus removed.

“My cancer had started spreading to other parts of the body. A hysterectomy was the only solution if I wanted to stay alive. My dream of birthing my own babies had to come to an end,” she sadly remembers.

After the hysterectomy, the bleeding and pain stopped and for the first time in 12 years, she did not have to wear a pad or carry an extra set of clothes in her handbag. It has been five years since Jacklyne had her uterus removed. The 40-yearold is still single, but hopes to find love someday.

“Most men want a woman who can bear them children. I am yet to meet a man who doesn’t want that. Maybe I will find him someday. For now, I am considering adopting a child,” she says.

Today, Jacklyne volunteers at the Texas Cancer Centre in Hurlingham, Nairobi, where she interacts with cancer patients and survivors.

Choriocarcinoma, the kind of cancer that Jacklyne had is a rare form of cancer. In majority of the cases, choriocarcinoma develops from Gestational Trophoblastic Disease (GTD), a group of diseases that see abnormal cells grow inside the uterus after conception.

The most common type of GTD is a hydatidiform mole, which is a tumour that forms inside the uterus at the beginning of a pregnancy. It results from an abnormal production of the tissue that is supposed to develop into the placenta, and is also referred to as a molar pregnancy.

However, in a few cases, choriocarcinoma can come about as a result of non-trophoblastic disease, where it is not pregnancy-related. Such is the case of Jacklyne, who developed this form of malignant tumour yet she was not pregnant.

According to Dr Amin Medhat, a gynaecologist and oncologist in Nairobi, this kind of cancer can originate from ovaries in women, or the testes in men. The choriocarcinomas, which result from genetic damage to a germ cell, make human chorionic gonadotropin (hCG) which is a hormone found only in pregnancy.

Dr Catherine Nyongesa, an oncologist, says that patients who present with choriocarcinoma give a positive pregnancy test results.

“This type of cancer is the only one that can cause a man to have a positive pregnancy test result. This is because it originates from some primitive cells in the testes. Therefore, if a man feels some swellings in his testicles, it is recommended that he sees a doctor immediately,” she says.

It is also these abnormal cells that may have caused Jacklyne’s tests to indicate a high hCG level (pregnancy hormones), even though she was not pregnant.

The symptoms of choriocarcinoma depend on the origin of the tumour. In the uterus, the most common symptom is bleeding, while in the ovaries, it is characterised by abdominal pain. In the testes, the choriocarcinomas present as small painless lumps.

According to Dr Medhat, most cases of choriocarcinoma can be treated if the correct diagnosis is made and treatment sought early.

“Treatment for choriocarcinoma includes chemotherapy, though in persistent cases surgery is necessary. All choriocarcinoma patients must be closely monitored following treatment,” he says.

In Kenya, cancer is the third leading cause of death, with a reported 40,000 new cases each year, according to Dr Nyongesa.

“Prostrate and oesophagus cancer is the most common among men, while in women, breast and cervical cancer lead the pack,” she says.

Cancer diagnosis, treatment and management still remains a problem in Kenya. In November 27-29, the Kenya Society of Haematology and Oncology will hold a conference that is expected to discuss issues surrounding cancer research, prevention, treatment, rehabilitation and palliation in Kenya.

With cancer treatment costs being out of reach for most Kenyans, it is hoped that the government and other stakeholders will come up with innovative strategies that can work towards enabling and ensuring the cancer cases in Kenya are reduced through prevention, early diagnosis and treatment in local health facilities.

Article courtesy: The Star

Sex and People with Disabilities

By Maryanne Waweru-Wanyama

Many are the times that Susan has come across people who have, with some astonishment, blatantly asked her, “You mean even people like you have sex?”  Such questions have come from her friends, relatives and strangers alike, and her reaction is almost always the same – one of consternation and bemusement at her sexuality.

You see, Susan, 25, has a physical disability. “Even though hurtful, I have learnt to live with society’s ignorance towards people like me,” she says.

One of the common societal attitudes towards people with disability is that they are asexual; that they do not have sexual relationships. Ignorance fuels these attitudes, where engaging in sexual intercourse does not seem acceptable – at least according to society.

Phitalis Were Masakhwe, a disability rights activist says the idea that people with disabilities do not engage in intimate relationships is the norm in society.

“People with disability are constantly portrayed as incapable of having sexual feelings. Yet, they are normal human beings who also seek meaningful relationships with members of the opposite sex. Just because one has a disability does not mean a diminished need to experience love and affection,” he says.

Often, sex is associated with physical fitness and the virility of youth. And with the media awash with the perfect body image, sex is also associated with the perfect physical body – one with a balanced symmetry devoid of physical limitations. Many people with disability, and especially women endure constant internal battles with the ideal body type, knowing only too well that they may never achieve it. For many, this affects their self-esteem and their relationships with other people, especially those of the opposite sex.

Susan says that society is fed on unrealistic images through the media – where boy meets a perfectly flawless beautiful girl, and they instantly fall in love.

“The sex which then follows is always mind-blowing. Physical attraction is always the dominant theme, and I am yet to see a soap opera that has the lead character as a person with disability. When cast in a programme, they are often portrayed negatively,” she says.

Besides the perfect body image, people with disability have a myriad of other issues to deal with, all of which can affect their sexual functioning. These include feelings of anxiety, fear and depression. Other times, certain prescribed medications may affect sex drive and sexual function.

For those with physical disabilities and whose mobility is aided by wheelchairs or crutches, their ability to move in what can be considered standard sexual ways is limited. Some have to contend with among others; pain and loss of sensation in areas where their partners expect them to be sensitive, as well as impaired bowel and bladder control. In men, it can have an effect on their erection and ejaculation.

For many people with disability, sex is not as spontaneous or as frequent as that of their able-bodied counterparts. Many times, it has to be a planned activity where issues of physical location and fatigue have to be considered. In some cases, the use of assistive devices to achieve pleasure is required.

“It takes a lot of effort and courage to explain some of these things to a sexual partner, especially one without disability,” says Susan. “That is why we prefer to date our kind most of the time – someone with a disability because they understand these things.”

Susan says that even though she gets attracted to people without disability, it is the fear of rejection that makes her stay away.

Even worse is the fact that some members of society consider it ‘embarrassing’ to date someone with a disability.

“Many men have sex with women with disability under the cover of darkness. They have intercourse with them at night but during the day, shun them. This accounts for the high number of women with disability who are single mothers. Often, their children have been sired by different men,” says Masakhwe.

Such a man, Masakhwe says, fears the likely ridicule he will receive from his family and friends, who will question his selection of a wife and tease him for his ‘unsuitable’ choice. “Such is the shame of our society”, he says.

In some communities, people with disabilities are often sterilized against their knowledge or will. Some women have even been forced to undergo abortions in the anticipated disgrace the pregnancy will bring to the family.

“It is this kind of prejudice that makes people with disability fear seeking health information,” Masakhwe says. “Even though sexually active, most lack confidence enough to seek information and services on ‘private matters’ such as reproductive health, even when this information is life-saving for them.

Caroline Agwanda, the proprietor of Hyacinth Ornament Production Enterprise (HOPE) in Kisumu, and who has a physical disability concurs with Masakhwe and further decries the reaction pregnant women with disability receive from society.

“Many express their sympathy at your pregnancy. They tell you ‘pole’ and question the morals of the man who ‘dared’ impregnate you. ‘What was he thinking? Why didn’t he look for another woman if he really wanted to have sex?’ they ask, while shaking their heads in disgust.

But it does not end there, Agwanda adds. “Woe unto you when society discovers that such a woman did indeed plan for the pregnancy,” says the mother of one.

“When I was expectant, many people asked me why I wanted to bring yet another disabled person into society. For them, it was automatic that I would give birth to a child with a bad leg like mine, and wondered what kind of a person I was to want to do so.”

Agwanda says that society’s ignorance on disability issues further manifested itself after she delivered. “After I got my baby girl, I was excited by the huge number of people who came to see me and my baby. However, I was to later discover that most were merely coming to ‘confirm’ that my child had been born with a bad leg too. This greatly saddened me.”

Too often, women with disabilities are teased, humiliated or otherwise harassed by peers and healthcare workers should they decide to become pregnant, decreasing the likelihood they will receive appropriate reproductive healthcare.

“Many are the times a clinician will ask a pregnant woman with disability; ‘Who got you pregnant? Why were you having sex in the first place?’ Even worse is that they ask this out loud along the hospital corridors, something that is really embarrassing,” says visually impaired Jacqueline Osoro, 31.

According to the Association for the Physically Disabled in Kenya (APDK), 1.6 million Kenyans have a form of disability.

Of these, about 640,000 are physically challenged. One such woman is Godliver Omondi from Mumias, who shares that pregnant women with physical disability have an especially hard time accessing antenatal care.

“I remember when I was pregnant, a nurse asked me to climb onto the examination table for an examination procedure during an antenatal visit. I use a wheelchair for mobility, and it is hard for me to get atop an examining table without assistance. The nurse did not bother to assist me,” says the mother of three children aged between five and twelve years.

“All health facilities must be made accessible to women with disabilities, and these include accessible examining tables, ramps and sign language interpreters. Clinicians should also be trained on how to be more sensitive to our needs,” she says.

One time when she was in labor and on her wheelchair, Godliver says many nurses passed her, assuming that she was there to visit a patient.

“I kept asking for assistance, and when I finally managed to catch the attention of one nurse, she asked me which patient I had come to see. The nurse was shocked when I told her I was in labor. She had not imagined that I could possibly be pregnant”.

Dr Julius Rogena of Machakos District Hospital admits to the lackluster attitude of health providers.

“Just like any other person, people with disability engage in behaviors which place them at various health risks, such as HIV infection. It is unfortunate that the attitudes of some healthcare workers do not reflect this reality.

As it is, people with disability have limited access to HIV education, information and prevention services. They may be turned away from community HIV education forums because of assumptions that they are not sexually active, and therefore at little or no risk of infection,” Dr Rogena says.

This is despite a growing body of research that indicates that those with disabilities are at increased risk of HIV due to their vulnerability.

Thoraya Obaid, Executive Director of the United Nations Population Fund (UNFPA) alludes to studies that show that persons with disabilities are up to three times more likely to be victims of physical and sexual abuse, and are at increased risk of HIV/Aids.

Yet for people with disability to be responsible about their reproductive health, they must be provided with sexual health information and given the safe space to openly express their sexuality. Rarely do adolescents with disabilities receive, either at home, or in school, reproductive health education that enables them to prepare for or appropriately respond to their specific needs and situations.

Jacqueline, who attended an integrated school for her secondary education says the only credible information she ever received on reproductive health was what she learnt during her form three biology class.

“Those who attend special schools hardly receive any sex education, and depend on those who listen to radio or television programmes to ‘educate’ them. Most of the information people with disability have on sex is what they learn from their peers,” she says.

Daniel Aghan, Advocacy Officer at Handicap International says there is an urgent need for the development of policies on access to disability-friendly information, education and communication materials, which take into consideration the different facets of disability.

For the visually impaired, Masakhwe advocates for their special needs.

“To protect themselves from HIV, blind persons use condoms, but their privacy is infringed when for example, they need to check the expiry date on the condom pack.

“They have to rely on a seeing person to read it for them. It is time brailed condoms were designed and made available to this population,” he argues.

Masakhwe says reproductive health programmes should be more accessible through disability-friendly adaptations such as cassette tapes, sign language interpretation, Brailled information, or in formats that are easily readable (such as pictures) for those with intellectual disabilities.

Article courtesy: The Star

Lilian Madonye: When Infertility Leads to a Life of Reckless Abandon

By Maryanne Waweru-Wanyama

When 37-year-old Lilian Madonye took her marriage vows 14 years ago, she looked forward to the exciting life that lay ahead of her. In her early twenties, she was marrying the man of her dreams, an athlete whom she had courted for two years.

The wedding marked the beginning of her new life, a life that would be filled with untold happiness from both her husband and the beautiful babies they would raise together.

Lillian, a second born in a family of three, had been raised in a relatively comfortable upbringing in Eldoret town. Her father, a banker, and her nurse mother had provided them with a stable home and good education.

Nurtured in a Christian environment, Lilian was a role model in her school, neighbourhood and church where she served as a worship leader. And her marriage did not disappoint.

Lilian Madonye

Photo: Lillian Madonye during the interview

The first year was full on love, warmth and laughter. However, in the second year, the couple became worried when they were unable to conceive.

After trying for a baby for three years in vain, Lilian decided to seek professional help and saw a doctor who put her on fertility drugs and supplements. However, the desire for a baby became a dominant, crippling thought which consumed her whole being.

“Sex became a laborious task that was no longer enjoyable because of the pressure to conceive. Family, friends, neighbours and church members were already spreading rumours about my barrenness,” she remembers.

Meanwhile, Lilian kept hopping from one doctor to another seeking a miracle treatment, but none helped her conceive.

“The day I would receive my period each month would send me to a very dark place where I would spend the duration of the menses in tears. Helpless, I wondered what worth I was as a woman if I could not bear a child. What justification did I have to call myself a woman if I could not have a child?” she asked herself.

Frustrated and at her wits end, she one day asked her husband to take a fertility test if only to encourage him to be part of their quest for a baby.

“Even though I knew I was the one with the problem because I believed that infertility was a condition only for women, I asked him to get tested anyway.” But the results of the semen analysis test on her husband shocked her.

“My husband had a low sperm count, hence my difficulty in conceiving! The news took me aback because all along I thought I was the one with the problem,” Lilian says.

A low sperm count decreases the odds of a sperm fertilising an egg which results in pregnancy. Lilian’s husband was then put on fertility treatment aimed at boosting his sperm count.

At the same time, out of curiosity, Lilian decided to take a fertility test as well, and whose results showed that she was perfectly capable of conceiving and bearing a child.

“I stopped all the drugs I was taking. I wished we had both done the tests earlier as it would have saved me all the medicines I had taken for three years!”

For the next two years, the couple continued trying for a baby, but were unsuccessful. During this time, their marriage began undergoing turmoil.

“We would constantly engage in verbal confrontations about anything and everything. We were both frustrated and very desperate about wanting a baby. At some point, the fights became physical. Our marriage became filled with extreme tension and anger. We both became very unhappy in our marriage. There were infidelity issues and I was constantly rebuking women with whom my husband was having dalliances with. We stopped talking and even slept in separate rooms. I felt there was nothing left to hold on to and I eventually walked out of my marriage,” she remembers.

Lilian then moved to Nairobi where she landed a job as a sales representative in a bank. Older, wiser and with her newfound freedom — her faith in God long gone, Lilian took to alcohol and drugs. A short while later, she got a transfer to Mombasa.

“As soon as I landed in the beautiful Coastal city, I met up with people who introduced me to a wide variety of hard drugs which were easily accessible unlike in Nairobi. Soon, I began engaging in prostitution to finance my new lifestyle as my salary could obviously not cater for my needs. I would have multiple affairs with married men who would take care of my different financial needs.

Lilian Madonye

Despite being aware of the dangers, I would have unprotected sex with my partners. I didn’t care about HIV, venereal diseases or drug overdoses because I had nothing to live for. With no husband and no children, my life had no meaning,” she confesses.

Lilian says she was on a constant high because when sober, the reality of her empty life would hit her, something she did not want to face. One morning after a night out, she began feeling sick.

“I knew that Aids had finally caught up with me,” she remembers. Lilian went to the hospital, but the doctor’s diagnosis shocked her. She recalls his words:

“Lilian, your HIV test is negative. But there is another test that has yielded positive results. Congratulations, you are pregnant!” She did not believe it.

“I was living a very evil life, engaging in all the abominable acts mentioned in the Bible, but yet God remembered me? I wondered why, yet when I was a good Christian, faithful in my marriage and with enviable morals, he ignored me. But now, when I was fully immersed in sin, he remembered me?”

Shocked to the bone, Lilian decided to sober up for the sake of her unborn baby. She packed all her belongings and moved back to Nairobi to start a new life.

She got back her old sales job at the bank, and began piecing her life together, which was not easy. “I was used to men taking care of all my bills, but now I had to support myself and my unborn baby. It became very difficult to make ends meet, but I did not despair. My baby motivated me and kept me going,” she says.

One day, in her seventh month of pregnancy, she noticed some blood stains. She rushed to hospital, and by the time she got there, her clothes were soaked in blood and she was writhing in pain.

An ultrasound done on the foetus revealed that Lilian’s baby was already dead. Lilian had faced high blood pressure issues during the pregnancy, which led to her having pre-eclampsia, a condition characterised by a high level of protein the urine and which can be fatal.

But she had to deliver the baby anyway, and after six agonising days, she finally gave birth. “It was a baby girl. Even though I wanted to see her and hold her in my arms, the doctors refused and only showed me her legs. They said that because she had been dead for more than a week, she was already decomposed and in a bad state. I called her Zawadi, because she was my special gift,” she says, struggling to contain the tears welling up in her eyes.

As she walked out of the hospital on that day in May 2012, Lilian left with a new resolve. To completely turn her life around and find her purpose in life again.

“I don’t blame anyone for the path I took in life. I am responsible for all the decisions I made. I could have made better choices, but I did not. I have forgiven myself and I am embracing my new life.”

In January this year, Lilian formed a group for women struggling with infertility. The group is called Diamonds Women Ministry, and it brings together women struggling with infertility, and teaches them to focus on other areas of their lives even as they try for a baby.

“The reality is that not all women struggling with infertility will have a happy ending where they will get pregnant and have babies. I encourage women not to be consumed by the search for a baby to the extent that other areas of their life suffers. They should also not peg their worth as women solely on the basis of motherhood. I talk to women during bridal showers and talk to newlyweds about marriage expectations. I always use my personal experiences because I know I contributed to the loss of my marriage and advice them not to make the mistakes I made. I am a strong believer in marriage and just because mine did not work, it does not mean that it will not work for another couple,” she concludes.

Article courtesy: The Star

Fistula: When Childbirth is a Cause for Misery

By Maryanne Waweru-Wanyama

Lovina Okwara is a bubbly 17-year-old whose broad smile, infectious laughter and carefree attitude is evident of a young woman enjoying her life. However, this has not always been Lovina’s attitude. For the last four years, her life has been one of misery.

Lovina traces it all back to four years ago when she gave birth to her daughter. An occasion that was supposed to bring her untold joy and happiness turned out to be the beginning of her nightmare. She recalls the day.

“My mother helped me birth my baby in our small house. Maternity services were not free back then so going to hospital was not an option as I had no money,” Lovina says, adding that the baby’s father, also a young man, had no financial means either.

Lovina comes from Teso district, Western Kenya. She comes from a poor background and so do many of her neighbours. Many of the women deliver their babies at home with no skilled care — among the reasons being personal preference, ignorance and poverty. While some women and children die during childbirth, Lovina and her daughter are among the lucky who survived.

But it was not an easy survival.

“I laboured for about 48 hours and when my baby finally came, I was exhausted, physically damaged and in pain. My private parts had been ripped apart during the delivery,” she remembers.

A few hours later, Lovina noticed she was unable to control her flow of urine and faeces.

“When I sat, I felt wetness overcome me and when I looked down, I noticed I was urinating on myself. I also noticed that my underwear had stool. Worried, I asked my mother about it.”

Lovina’s mother reassured her that the leaking urine and faeces were nothing to worry about, that many other mothers experienced it too.

This situation would see Lovina, who dropped out of school in class seven, eat very little food and take few sips of liquids to avoid quickly filling up her bladder and bowels.

“I would starve myself yet I was breastfeeding. I also stopped laughing as this would make my urine gush out. Even though I am grateful for my daughter, it has been a harrowing experience for me ever since she was born,” she says.

When Lovina, a causal labourer in Nairobi, tried to seek treatment for her condition, she learnt it would cost her about Sh30,000, money she could not raise. So it therefore came as a pleasant surprise when in July this year, she came across information about a free fistula medical camp at Kenyatta National Hospital.

Lovina wasted no time in going to the hospital for screening and a few days later, underwent a successful fistula repair surgery. Today, she is a happy teenager who has since regained her cheer and laughter which had been taken away by the fistula she suffered for four years.

Lovina Okwara

Photo: Lovina Okwara

Lovina’s fistula is likely to have been caused by the prolonged labour she went through. According to Dr Stephen Mutiso, a gynaecologist and fistula repair surgeon at Kenyatta National Hospital, obstetric fistula is a childbirth injury that develops due to prolonged and neglected labour which becomes obstructed.

“Obstructed labour causes destruction of vaginal tissue which leads to the development of a hole (fistula) between the bladder and birth canal. This causes urine to leak continuously through this hole. When the same damage occurs between the rectum and the birth canal, faeces leak continuously from the rectum to the birth canal,” he says.

Prolonged labour is that which goes on for more than 24 hours and according to the World Health Organization, obstructed labour accounts for up to six per cent of all maternal deaths. Dr Mutiso says that majority of the patients who present with fistula often have laboured for three to five days at home usually under the assistance of relatives or traditional birth attendants. In most of these cases, nine out of ten babies are born dead. Many of the women are from remote areas where the overall infrastructure is poor and they are unable to reach hospitals in good time.

In Mwingi district, Kitui County in Eastern province for example, women have to walk long distances in rough terrain to the nearest health centre. And when they get there, lack of personnel as well as lack of equipment and supplies is yet another challenge. A case example is Nyaani dispensary in Nuu location, where there is only one health worker, a community nurse who attends to all patients seeking services there. Nyaani dispensary serves a population of about 7,000 people.

Without a theatre or other basic equipment necessary for handling birth complications, the nurse has to call for an ambulance from Mwingi District Hospital which is 79km away. By the time the ambulance arrives and gets the pregnant woman to hospital, about four hours have elapsed. And this is when an ambulance is available. Many times it is not.

“A pregnant woman experiencing a birth complication and who is referred to the district hospital often has to use public transport. Public vehicles are hard to come by because of the poor state of the roads. Sourcing for transport and eventually getting to the hospital can even take a day,” says Damaris Wanjiru, the nurse in-charge at Nyaani dispensary.

Interestingly, while Damaris sees an average of 12 pregnant women a month attending antenatal clinics, she only delivers about three babies a month, with the rest delivering at home. Lack of transport is one of the major reasons the women cite for failing to make it to the dispensary when labour checks in.

Eastern province is one of the regions that bears the highest number of fistula cases. Other areas include Nyanza, Coast and Northern Kenya regions, as well as West Pokot. It is important to note that fistula can affect any woman regardless of her age, marital status, education level or income status. For as long as she experiences prolonged and obstructed labour and does not have access to emergency and quality obstetric intervention, then she can develop fistula.

In Kenya, there are an estimated 300,000 women living with fistula, with an occurrence of about 1,000 new fistulas each year, according to Dr Mutiso.

The consequences of fistula on the woman are dire. Stella Mburu, a nurse at Mbagathi District Hospital and who has been trained in fistula care, says that in most of the cases, the woman is emotionally pained following the loss of her baby. In addition, she has to deal with the continuous leaking of urine or faeces which make her smell foul. Most women from poor areas cannot afford fistula repair surgery and therefore use pieces of old cloth or mattresses to contain the leaking urine or faeces.

“They face rejection by their families and communities and because of the stigma, they soon stop going to public places such as the church or the market. They also stop attending social gatherings like weddings or chama. They also find it hard to find employment or engage in business. Some women experience domestic violence while some are disowned by their men who leave them to marry other women. Some women suffer depression as a result,” she says.

The good news is that fistula is treatable. Small fistulas can heal if a urinary bladder catheter is inserted for about four weeks immediately the fistula occurs. Surgery is the other option. However, the costs of surgery remain far beyond the reach of many women affected by fistula. In public hospitals, fistula repair surgery costs between Sh20,000 and Sh40,000 which is a subsidised fee. In private hospitals the price is much higher.

For women such as Lovina who cannot even afford the subsidised cost at government hospitals, they are lucky to benefit from organisations that sponsor their treatment through free fistula medical camps. Her surgery was made possible by the Freedom from Fistula Foundation, the Flying Doctors Society of Africa and Kenyatta National Hospital.

Fistula can be prevented by delaying the age of pregnancy and ensuring that all women have access to quality maternal care. The free maternity services in public health facilities are aimed at encouraging more women to deliver in hospitals under the supervision of skilled birth attendants to reduce negative maternal outcomes such as fistula.

Article courtesy: The Star

Dads Have an Important Role to Play in Breastfeeding

By Maryanne Waweru-Wanyama

Many new mothers know that breastfeeding their babies is the best way to give them a healthy start to life. The good thing is that most fathers know this too! Indeed, the benefits of breastmilk abound.

Breastmilk is the perfect food for babies as it provides them with all the nourishment they need for their first six months of life. Because of the antibodies in it, breastmilk increases a child’s ability to fight off infection. This means that a breastfed baby has fewer trips to the doctor because of their strengthened immune system.

Less medical bills also means the family is able to save and channel their finances to other investments. In addition, the skin-skin touch during breastfeeding between mother and baby enhances the lifelong bond between them.

The World Health Organisation recommends that babies be exclusively breastfed for the first six months of life — meaning they take breastmilk only during this time. To achieve this goal, a mother needs support from the people around her and one of the most important people who can support her is the baby’s father.

Interestingly, breastfeeding does not come easy for most new mothers, and many need to be taught how to go about it. If her baby does not latch properly, then she may experience problems such as cracked, bleeding nipples which can cause her unbearable pain and discourage her from going on.

Also, when baby does not latch properly, it means he is not feeding well and this may cause him to become dehydrated. Her husband can assist in ensuring that she leaves the hospital having been taught how to place baby on the breast for a proper latch. He can be present as she is taught how to do so for purposes of assisting her after their return home in case she experiences latching difficulties.

Being a new mom can also take a toll on even the strongest of women. The fatigue of the nine-month pregnancy coupled with sleepless nights, changing diapers, rocking the baby to sleep, hosting visitors during the day, nursing a wound if she delivered via caesarean section, bathing baby and other such tasks can be quite challenging. When a nursing mother is stressed, it can affect her ability to produce sufficient milk for her baby.

Her partner can help by undertaking some of these chores, such as changing diapers, bathing baby or taking him out for walks to get some sunshine.

When the baby wakes up at night, the father can pick him up from his crib and bring him over to his mother for nursing. After the breastfeeding session, the father can take him again, burp him and then rock him back to sleep. This allows the mother to rest before the baby’s next feed.

Due to the dietary needs of a breastfeeding mother, her husband can ensure that her food is well balanced by doing grocery shopping and buying all the foods and supplements she requires. In between night feeds, he can offer his wife a glass of water, prepare her a cup of hot chocolate or warm some porridge for her.

More importantly, he should support her emotionally and offer her words of comfort on the days she feels overwhelmed. If left unchecked, the rigours of being a new mom could lead to post-partum depression. He should ensure her environment is stress-free and he should never stop showing her genuine love, concern and care.

When her husband is supportive, a new mother is able to breastfeed for longer thus giving her baby a healthy start to life. Men should remember that babies who are breastfed exclusively for the first six months have stronger immunity, meaning less hospital visits in the future and less financial costs for the family. They should know that investing in breastfeeding is investing in their child’s healthy future.

Article courtesy: The Star

Former Female Prisoner Helping Society Accept Ex-Convicts

By Maryanne Waweru-Wanyama

For more than seven years, Elizabeth Ndunge engaged in a lucrative business at Gikomba market in Nairobi, where she traded in second-hand clothes. As the business grew, she partnered with two friends and they would buy clothes in bales and then sell them in Juba – South Sudan, where they had established a new market. Each week, the ladies would take turns to travel to Juba, sell the clothes then return after three or four days when the stock was sold out.

Elizabeth Ndunge

Photo: Elizabeth Ndunge during  the interview

“Business was very good, and we were all happy with the huge profits we were making,” remembers the 42 year-old mother of two.

“We would buy about five bales, and then hire one of our regular taxi drivers to take us to the town center from where one of us would board a bus to Juba,” she remembers.

This arrangement went on smoothly for three years, until one day, an unexpected event altered the course of Ndunge’s life forever.

“It was a morning February 2008, and it happened to be my turn to travel to Juba. After purchasing the bales at Gikomba, I waited for my regular taxi driver to take me to the town center. Unfortunately, he delayed, and fearing I would miss my bus, I decided to take the first taxi that came my way.”

And that was to be the decision that would cost her dearly.

“I negotiated the fare with the driver, and after reaching an agreement, I boarded the taxi. The drive was smooth, but just as we were about to get into the town center at the Muthurwa market roundabout, I heard the taxi driver murmur some words before suddenly changing routes. When I asked him why, yet we were almost at our destination, he said he was avoiding traffic. However, I noticed there were policemen ahead of us, and I thought he could have been avoiding them perhaps because he didn’t have a driving licence,” Ndunge recalls.

But she became worried when the car began heading further away from the town center. The taxi driver kept going on, ignoring her pleas to drop her off at the next bus stop. She sensed danger when they got onto Mombasa road.

“Each time I asked him where we were going, he ignored me. Frightened, I even wet my pants, believing I had been kidnapped,” she remembers.

Shortly thereafter, Ndunge suddenly heard loud bangs coming from behind. Instinctively, she ducked down to the floor of the car, realising that the sounds were gunshots.

“I then heard the taxi driver open his door and jump out, leaving the car on its own motion. I felt the car enter a ditch and come to a halt.”

Ndunge recalls struggling to get out of the car, and when she finally did so, she raised her hands in the air screaming out for help. She was grateful when she saw policemen rushing towards her, glad that they would rescue her from her kidnapper. But she was in for a rude shock when the same policemen immediately pounced on her with slaps, kicks and blows.

“As they rained punches on me, asking me to name my accomplice (the taxi driver), it was only then that I realised that the car had been stolen! The policemen stripped me naked by the roadside and tortured me for about three hours, asking me to reveal other members of the car theft syndicate. I was saved from death by the crowd of onlookers who begged for the policemen to spare my life,” she remembers.

At the Langata police station, Ndunge was booked, and there began her court case where she stood trial for the capital offence of armed robbery. The prolonged court case would see her stay in remand for three years. Eventually, she was found not guilty of the robbery with violence charges. However, the judge ordered her to serve 12 months in jail for the offense of being found in a stolen vehicle.

“The judge ruled that it was wrong for me to have boarded a ‘taxi’ that bore no yellow-line, or which was not branded a taxi company’s name. She explained that anybody found in a car that has been reported stolen must answer to charges of theft of the vehicle. She said my sentence would serve as a warning to me and others who board unbranded taxis.”

Having already served slightly over three years in remand, Ndunge decided to make the best of her remaining time behind bars. During the course of her year-long jail term, she began composing gospel songs which she would later record.

While incarcerated, she began noticing that many prisoners, once released, would after a short while return to prison.

“We would spend the eve of her release singing, dancing and praying together, wishing our sister a good life outside the prison walls. But less than a month later, we would see the same woman return. It happened to so many times, and it became an issue that deeply troubled me. One day I gathered courage to inquire about the disturbing trend.”

All the returnees Ndunge talked to all said the same thing.

“They said that once freed, they faced so much stigma and rejection by society that they longed to return to prison. Rejected by their families, friends, neighbours and former colleagues, they found it hard to settle down and make a decent living. Distraught, they would deliberately commit a crime so that they would return to prison –the only home they had come to know. In prison, they were guaranteed of acceptance, friends, food, shelter and clothing.”

As she listened to their experiences, Ndunge hoped that her family would not reject her. She could not fathom the idea of returning to prison no matter the challenges out there.

Finally, her release day arrived in October 2012, and after leaving the prison gates, she vowed she would not return there. She travelled to her rural home in Kangundo, Machakos County, unsure of the reception she’d get.

“Thankfully, my family welcomed me back. Sadly though, my husband had already remarried. I chose to accept and move on with my two children, who had been left under the care of my mother. Shortly thereafter, I returned to my former business in Gikomba, where I was welcomed back by my former colleagues. Relieved, and knowing that acceptance of ex-convicts into society was a possibility, I decided to use the profits of my business to help women ex-convicts so that they too could be accepted back into society.”

Ndunge began offering help to ex-convicts facing problems of rejection by their families after their release by mediating between both parties. As her work progressed, Ndunge decided to make her venture more formal, and in 2013, she registered the organization Kenya Ex-Prisoners Fighting Acceptance Back into Society (Kefabis).

So far, Ndunge has been able to help 29 female ex-convicts be accepted back by their families, after initially being rejected. She sometimes requests the assistance of local chiefs, respected community leaders as well as religious leaders to help in the mediation process. Her initiative has seen her travel across the country, with some of her travel expenses being taken care of by the Missionaries of Africa –a Catholic based society whom she became acquainted with while in prison.

Today, Kefabis has 2,600 members, many of whom have established support groups as a way for helping and motivating each other to live by the law.

“In Kangundo, members have formed a group where they engage in commercial farming activities. In Malinidi, the women engage in craft work while in Kisumu, they engage in evangelical ministry. The Kefabis Kakamega chapter recently received training from a painting company, where they were taught how to paint professionally. The members often get contracts to do painting jobs, and are earning money from this. In Nairobi, members design and tailor clothes, jewellery and other accessories such as handbags. Most of these women use the skills they learnt while in prison,” she says.

Her work has however not been without challenges. Many are the times she has been chased by family members of the ex-prisoner she is trying to mediate for.

“Both of us are hounded out, as the families want nothing to do with ex-prisoners. Many are the times we have been thrown out violently,” she says.

“It is also disheartening when some families completely reject their family member. Two women have so far been completely rejected by their kin,” she says.

But Ndunge soldiers on, because as an ex-convict, she understands the stigma associated with former prisoners.

“I know what it is like to be stigmatised by society. Today, not all my friends have accepted me as some fear me thinking that I am a dangerous criminal. But that will not stop me from doing my work of helping female ex-prisoners rebuild their lives again,” she concludes.

*Ndunge is reachable on 0708898542

Article courtesy: The Star

Senator Harold Kipchumba: “Polio Shattered my Dream to be a Soldier”

By Maryanne Waweru-Wanyama

Anti-polio campaign ambassador Harold Kipchumba, who was paralysed when he was four, appeals to parents to ensure their children get all required immunisation

Growing up as a young boy in the small village of Kaptiony in Baringo County, 52-year-old Harold Kipchumba vividly remembers some of his childhood escapades.

“I would run wildly with other boys picking wild fruits, playing hide and seek games and chasing after birds while herding cattle.”

This however changed one day when at four years old; Kipchumba began feeling unwell.

“I felt pain in my body, I felt tired and I felt weak. Unable to get out and play with my friends, I remained indoors with my mother,” he remembers.

But his mother thought he was just being lazy.

“She scolded me, saying I was being sluggish because I wanted to avoid doing house chores such as fetching water and firewood. She thought I only wanted to eat and sleep.”

Harold Kipchumba

Photo: Harold Kipchumba during the interview 

Within a week, Kipchumba found himself completely unable to move his body from the waist down, especially his legs. It was only then that his parents took the matter seriously.

“They thought someone had poisoned me and pestered me about whose home I had visited and what I had eaten there. They asked who I had met along the way, and if the person had looked at me with bad eyes — thinking that a jealous neighbour had bewitched me. They also asked if I had eaten any wild fruits that may have been poisonous, or if I had touched any wild leaves that could have caused an allergic reaction on my legs,” he recalls.

His parents then sought the expertise of local herbalists to help cure their son.

“The medicine men made me swallow bitter concoctions. They would painfully massage my legs with traditional herbs and oils as they tried to straighten them. But none of their cures worked.”

Finally, after two months and with his legs still immobile, Kipchumba’s parents decided to take him to hospital.

And therein lay another challenge.

The nearest health centre was 40 km away from Kaptiony village. With no public transport in the area, the family had to wait for days for a Good Samaritan to offer them transport.

Eventually, Kipchumba and his parents reached the hospital. But there was no good news for them.

“The doctor said I had polio, which was irreversible. They told my parents that the condition could have been prevented if they had been keen on ensuring I had received all the polio vaccines in my early childhood.”

Kipchumba’s mother did not take the news of her son’s paralysis well, and spent years seeking a cure for him.

“She took me to countless traditional medicine men across the country — from Ukambani, to Kisii, to Kisumu. But none of them ever healed me. It was an exhausting experience for her, as she would get weary carrying me on her back as I was unable to walk or stand. I was big and heavy, but her determination is what kept her going,” he recalls.

Back in the village, Kipchumba would admire his age mates who had already started school.

“I was not in school because the interview for class one required one to touch their left ear with the right hand. I was short and plump with a big head and a very heavy upper body, so I repeatedly failed this test because I could not get my hand over my head. I watched all my age mates go to school while I stayed at home simply because I could not pass this interview,” he recalls.

Frustrated, Kipchumba’s mother decided to return him to hospital. And then she did the unexpected.

“My mother dropped me at the hospital and left, never to return for me. After a while, some Catholic nuns noticed me and took me with them to Nyabondo Home for the Crippled in Kisumu. There, I underwent rehabilitation for my legs, and I was also able to get an education.”

However, the young boy always remained hopeful that his mother would return for him someday.

“As I watched my friends get visited by their family on visiting days and be picked by their parents on closing day, I always stared at the gate, looking out for my mother. But she never came.”

That notwithstanding, Kipchumba was a bright pupil, and scored well enough to earn him a spot in Lenana School, a national school in Nairobi. While there, the school helped trace his family. It had been more than 13 years since he had seen his mother. He remembers the reunion.

“I cannot forget that moment. I was overjoyed. On seeing me, my mother shed tears, apologising profusely — saying she had never meant to leave me at the hospital, but had done so out of helplessness and frustration. Begging for my forgiveness, mother told me she had spent years regretting her decision to abandon me. I was too happy to see her and easily forgave her. I was also reunited with my siblings, including those who had been born after I had left,” he says.

After competing secondary school, Kipchumba was admitted to Kenyatta College (now university) for a degree course, but turned it down for an offer at Kimmage Development Centre in Ireland where he pursued development studies. He however says that one of his greatest dreams while growing up was to be a military man.

“When I showed up for the recruitment exercise in 1986 at the age of 24 years, the officers were shocked at my presence. They asked me why I was there, yet they had made it very clear that they wanted youths who were physically fit.

“I argued with them, saying I was physically fit, only that I was in crutches. Besides, I told them that I was capable enough to serve in the military in the administration, logistics or planning departments. But they turned me away.”

Dejected, the young Kipchumba returned home.

“If my mother had ensured I had received those two polio drops, then my dream to serve in Kenya’s Defence Forces would have been valid, just like Lupita’s.”

Principal Secretary for Health Prof Fred Sigor, Baringo County Governor Benjamin Cheboi and anti-polio campaign ambassador Harold Kipchumba during the world Health Day celebration in Marigat in April

Kipchumba during the World Health Day celebrations

Kipchumba, who holds a Masters degree in Local Governance and Leadership, is today a development consultant. Married with three children, he finds time off his busy schedule to participate in polio campaigns. He works together with the Ministry of Health to champion the cause of polio across the country.

Polio is an infectious disease that attacks the nervous system and can lead to paralysis, disability or even death. The polio virus enters the body through the mouth in water or food that has been contaminated with faecal material from an infected person.

The disease mainly affects children under five years old who are not fully vaccinated. Children in Kenya are vaccinated against polio in routine immunisations through the Kenya Expanded Programme of Vaccination (Kepi). They are required to receive at least four doses of the oral polio vaccine in the first year of life. Polio symptoms include fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. For every 200 people infected with polio, one of them ends up with irreversible paralysis (usually in the legs). Among those paralysed, 5 – 10 per cent die when their breathing muscles become immobilised by the virus.

While many countries across the world have managed to completely eradicate polio, others still continue to grapple with this preventable disease. Kenya is one of them, and has an interesting history to it.

For 22 years from 1984 to 2006, Kenya was polio-free. However, this changed with the influx of foreign nationals into the country, mainly those from neighbouring countries. In 2006, two polio cases were reported in the country, which were importations from Somalia. In 2009, there were 19 detected cases of the virus in Turkana, which were importations from South Sudan. Another case was detected in Rongo, Nyanza province in 2011, and which was linked to the 2010 outbreak in Uganda — which was in turn linked to the 2009 outbreak in Kenya. As of December 2013, there were 14 confirmed cases in the country.

In light of this, the Ministry of Heath has been working with partners such as Unicef, World Health Organisation, and polio ambassadors such as Kipchumba in conducting mass immunisation campaigns to ensure all children are vaccinated against polio. Polio has no cure, and can only be prevented through immunisation.

According to Dr Ian Njeru, the head of the Division of Disease Surveillance and Response, these campaigns will continue taking place until all children are reached.

“All children in the country must be immunised, because for as long as there is a detected polio case, then all children across the country are at risk,” he says.

The polio virus knows no borders and carriers frequently move from place to place. Meaning the virus can appear anywhere in the country. Despite heightened awareness campaigns, the ministry is still not achieving its target of having more than 90 per cent of children immunised.

“Some of the barriers include religious sects that do not believe in vaccination or modern medicine. The poor infrastructure and dire security situation in some regions has also made it hard for us to reach all children,” he says.

According to Dr Njeru, children who have received previous polio vaccines should still be immunised in every campaign.

“It is safe to administer multiple doses of the polio vaccine to children. The extra doses give valuable additional immunity against polio,” he says.

Article courtesy: The Star

Does Being Short Disqualify a Pregnant Woman from Natural Birth?

By Maryanne Waweru-Wanyama

When Valerie Kasaya was in her eighth month of pregnancy, she one day noticed an unusual discharge. Having had a smooth pregnancy all along, the discharge deeply worried her.

A resident of Kawangware slums in Nairobi, 20-year-old Valerie decided to go for a checkup at a public health facility in Westlands, a distance of about 14km away. That is where she had been attending her antenatal clinics.

At the clinic, Valerie was informed that her cervix had started opening, that she could give birth anytime. The nurses further told her to begin preparing for a caesarean section as it would be impossible for her to deliver naturally.

“Nurses told me that because I was short, this meant that my pelvic bones were small, indicating that a natural birth would not be possible,” she recalls.

Valerie is just about five feet tall. The attending nurse then referred her to Kenyatta National Hospital (KNH) since the clinic did not have the facilities required for the surgery.

“Even though I was disappointed to learn that I would not deliver normally, I trusted the medic’s verdict because they are the experts,” she says. But back home, Valerie’s mother would hear none of it.

“My mother insisted that I could still give birth naturally. She said she had seen shorter women than me deliver naturally. She asked me to seek a second opinion, and accompanied me to a nearby clinic.”

Valerie Kasaya with her baby

Photo: Valerie Kasaya with her baby.

At FreMo clinic, a small privately-run health centre that serves the low-income population of Kawangware, Valerie and her mother were excited to learn that physical stature alone is not enough to determine if a woman will give birth normally or not.

“The midwife at FreMo said they would let me try natural birth first and if it failed, then they would refer me to KNH for a caesarean section,” recalls Valerie. She was then sent home and asked to return when labour started.

A few days later, labour started, and she immediately walked to the clinic — a distance of about two kilometres. During labour and while waiting for her cervix to fully dilate, the attending midwife helped Valerie engage in some exercises.

“She made me swing my hips, squat, and also instructed me on how to breathe. She said all this would help the baby descend, as well as ease my labour.”

Four hours after the onset of labour, Valerie delivered a healthy baby boy weighing 3.1kg. During delivery, it was just her and the midwife and she had a smooth delivery with no complications. She did not even have an episiotomy (surgical incision on the posterior vaginal wall during labour).

“I was surprised because I had successfully delivered my son naturally, yet other nurses had told me that I was a direct caesarean candidate because of my small stature,” she says.

Both mother and baby continue to enjoy robust health with no complications. Her son is now seven months old. Magdalene Katuku, the midwife who helped Valerie birth her baby, says that it is possible for short women to deliver naturally.

“Natural birth is determined by a number of factors, and it is wrong for one to make assumptions based on height alone. Having a small stature does not disqualify one from a natural birth. It all depends on the size of the baby, and the size of the pelvis. A big woman can have a small pelvis, which may not allow the baby to pass through, as her baby might be big. In the same breath, a small woman can have an adequate pelvis that may allow her baby to pass through,” she says.

At FreMo clinic, Magdalene says the emphasis is on natural delivery. Last year alone, of the 211 deliveries, 207 were natural births, with four being referred for caesarean section to KNH when there were obvious indications that a normal delivery would not be possible.

Magdalene says that their successful rate for natural births is by design, not coincidence. “Throughout the pregnancy, we help the women engage in certain activities that help keep her fit and which boost her chances for a natural birth,” she says.

Pregnant women who attend clinics at FreMo learn about chest stretches, which reduce pregnancy aches and pains and improve blood circulation. They also learn about exercises that reduce back pain — a common concern in pregnancy.

In addition, the midwives teach the women how to do special press-ups, which help prevent aches and pains due to the growing belly. “We encourage the pregnant woman to walk throughout her pregnancy. Walking is a good cardiovascular exercise, and helps keeps her fit. She should however be cautious not to walk to the point of exhaustion or breathlessness,” says Magdalene.

FreMo clinic also offers free childbirth classes for women in their last trimester. Here, they are given information about the birth process, where they are taken through the stages of a natural delivery.

“We encourage them to come with their spouses for moral support. It helps the couple prepare themselves psychologically for labour, and build their confidence about the birth process. During childbirth classes, we answer all their questions as they share their fears and expectations. We reassure them, helping them build confidence in the body’s ability to birth a baby,” she says. Their partners also learn how they can support the woman during labour, such as helping her with breathing exercises and massaging her back.

During labour, the pregnant women are encouraged to squat, as this not only speeds up labour but also fastens the opening up of the pelvis, providing room for the baby to descend. They are not encouraged to lie on their back, as this slows down baby’s descent therefore prolonging labour.

“We are also never in a hurry when the woman is labouring. We are patient with her, and attend to her throughout the birth process, the ultimate goal being a healthy baby. Due to the close monitoring, we are able to assess and anticipate any complications that would necessitate an immediate referral and transfer to KNH, which we facilitate as we offer them transportation. All the above are what we believe has led to our high success of normal deliveries,” she says.

 

An expert’s view

Is it possible to tell if a woman will not be able to have a natural delivery judging solely by her height? According to Dr Stephen Mutiso, an obstetrician / gynaecologist at Kenyatta National Hospital, a diagnosis of cephalo-pelvic disproportion (CPD) is often the key determinant in such cases. Cephalo refers to the size of the baby’s head, and pelvic means the size of the birth passage.

A diagnosis of CPD means that either the baby’s head is too big for the woman’s pelvis, or the pelvis is too small for a normal sized baby. In women diagnosed with CPD, normal delivery is difficult and at times impossible.

“Small women tend to have a small pelvis, and are likely to have difficulties during delivery. Any woman with a small pelvis and whose baby indicates being slightly bigger compared to her pelvis is not advised to try normal delivery,” he says.

However, Dr Mutiso clarifies that there are short women who have small babies and go on to have successful normal deliveries, hence the need for proper assessment by the health professional during antenatal care or when labour begins.

“This assessment will help determine if the pelvis is adequate enough to allow baby to pass through. If the baby’s size is small to average, then labour should be considered,” he says. Dr Mutiso warns of attempts to push a baby that cannot pass through a small pelvis.

“This could lead to prolonged labour and cause obstruction, which in turn may result in complications such as fistula, rupture of the uterus, serious infection, excessive bleeding after birth and foetal distress. In some instances both mother and baby may die.”

Dr Mutiso says that in the event vaginal delivery goes on to take place, the mother can sustain serious perineal tears or cause damage to her reproductive organs. Further, caesarean deliveries done when one has been trying to push are more difficult and associated with increased complications.

“In as much as most pregnant women plan to delivery naturally, it is necessary for them to understand that complications may arise during labour, and which may necessitate a caesarean section. These complications include failure for labour to progress despite good contractions, foetal distress and excessive bleeding.”

Article courtesy: The Star

Warning Sins in Pregnancy: When to Call Your Doctor

During pregnancy, many women have lots of questions and queries. Some of them we ask our moms, our aunts, our friends, our colleagues, and some of us go to Facebook to seek answers :) . But, when does it become obvious that you need to call your doctor or midwife, or visit the health center immediately?

Dr. Stephen Mutiso, a consultant obstetrician/gynaecologist at KNH is our guest writer today and he lets us in on the warning signs –when a pregnant woman should seek a medic’s opinion as soon as possible.

*Antenatal care entails monthly visits to the clinic till 28 weeks gestation, then visits every two weekstill 36 weeks, and thereafter weekly visits till delivery –for those progressing well. However, sometimes there is variation from this schedule, and this depends on the needs of the expectant mother.

However there are certain situations when it becomes necessary to get in touch with your gynaecologist on an urgent basis before the next visit. This is especially when certain complications develop.

Complications during pregnancy and childbirth are common. Infact, approximately two out of every five pregnant women experience some complication during pregnancy, childbirth and postpartum period. 15 percent of pregnant women develop life-threatening complications. Most complications cannot be predicted and can happen at any point during the antenatal period, during delivery or post-delivery. Therefore, all pregnant women should be prepared to respond appropriately when complications arise by contacting their care givers immediately.

There are certain symptoms which if present denote that they could be serious complications hence need to act immediately. These symptoms are referred as danger signs. Knowledge of danger signs of pregnancy emergencies and appreciation of the need for rapid and appropriate response when they occur is important to avert fatal outcomes. At times, getting medical help early  makes the difference between survival and death.

The danger signs in pregnancy are: vaginal bleeding, severe headache, severe vomiting, swelling of hands and face, difficulty in breathing, fits, fever, reduction or absent fetal movements, gush of fluid, intense abdominal pain and contractions before 37 weeks. Danger signs indicate a woman needs immediate medical care.

Bleeding is a very serious complication. It causes most of the maternal and foetal deaths in Kenya. Any bleeding in pregnancy –irrespective of the amount is abnormal. When bleeding is present during pregnancy it may indicate that the placenta position is on the lower aspect of the womb (placenta praevia). Bleeding may also occur when there is premature separation of the placenta. This premature separation cuts off delivery of oxygen and other nutrients to the baby, and this could lead to the baby’s death. Other causes of bleeding in pregnancy include: rupture of the uterus and bleeding from the baby (though this is rare). Heavy bleeding after delivery may arise from different causes such as relaxation of the uterus (atony), injuries in the birth canal, incomplete expulsion of placenta and sometimes bleeding disorders.

Severe headache, swelling of hands and face, blurred vision, fits and difficulty in breathing indicate high blood pressure and need urgent attention. This complication is referred to as severe preeclampsia, and when fits are present it is called eclampsia. This disease is also deadly and delivery is the way out regardless of whether the baby is mature or not. Seekng immediate care from your gynaecologist is important.

Hotness of the body with or without vomiting may indicate presence of serious infection or malaria. Prompt treatment does save life.

When waters break it is important to call your doctor immediately, because there is a possibility that the baby’s cord can come out and get compressed by the baby’s head, thereby stopping blood supply to the baby. This can cause death of the baby. It is also very easy for infection in the uterus to set in once the waters break. This infection is life threatening. Urgent care is therefore crucial.

Pregnant mothers should be keen on foetal movements (kicks) throughout their pregnancy. Any decrease in baby’s movement may indicate that all may not be well with the baby, and so it is important for the woman to report this observation to her gynaecologist as soon as possible.

Intense abdominal pains require urgent evaluation by your doctor. Causes of severe abdominal pain include ectopic pregnancy; rupture of uterus, premature separation, infection of the kidney. At times, abdominal pain may be due to surgical diseases such as appendicitis, intestinal obstruction etc.

Contractions which occur before 37 weeks indicate premature labour. Babies born at this time could develop breathing difficulties which sometimes could prove fatal. Its advisable for expectant women to seek assistance when they start getting regular uterine contractions especially if there are more frequently than 10 minutes apart.

In conclusion, knowledge of danger signs is important because it improves complication recognition and ensures timely decision to seek care hence handling complications in good time and consequently saving lives and avoiding serious disabilities.*


Dr. Stephen Mutiso is based at the KNH Doctor’s Plaza, Suite 26/27. He provides a  wide range of  gynaecological services including: antenatal care, delivery (normal and caesarean),  infertility  treatment, fibroids, fistula surgery, screening for reproductive tract cancers and various  gynaecological operations.

Tel: 0722 678 002 or 0788 306 674

Website: drmutiso.com Email: mutisoh@yahoo.com

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